Accurate and complete disease surveillance is critical to enable public health authorities to detect and respond to disease outbreaks, epidemics, and even bioterrorism events. While legally required of healthcare practitioners and practices, most notifiable disease reporting is still done manually or through limited automated laboratory test result reporting. This creates a substantial burden on practitioners and produces sparse data that does not meet the full requirements of the agencies responsible for protecting public health. To address limitations in reporting and surveillance, the Centers for Disease Control and Prevention, beginning in 2005, sponsored a project to develop and pilot an open-source electronic system (called EHR Support for Public Health, or ESP) to automate the detection and reporting of notifiable diseases by taking advantage of the rich information coded into electronic health record (EHR) systems. Collaborating institutions included Harvard Medical School, Harvard Vanguard Medical Associates, and the Massachusetts Department of Public Health. CDC and AHRQ subsequently funded the creation of additional prototypes for syndromic surveillance, chronic disease prevalence monitoring, and automated detection and reporting of vaccine adverse events, as well as the fielding of ESP as a vehicle for enhanced surveillance of sexually transmitted diseases. We believe that ESP is a near-perfect basis for the NIH's Lab to Marketplace (Tools for Biomedical and Behavioral Research) SBIR solicitation. It represents advanced, proven-to-be-useful technology that was developed with substantial DHHS investment, but it is only in use so far at a handful of institutions. There is a real danger that ESP will never attain lift-off as a sustained, viable commercial activity. The overall goalsof this project are to realize the full functional potential of ESP, to make it more robust and easier to use and deploy, and to take the necessary steps to move it onto a pathway to wider deployment. Specifically, the project will take advantage of emerging healthcare data standards to increase portability of ESP across EHR systems and to reduce the maintenance and management burden on healthcare practices for the setup and use of ESP and for access to the data captured by the system. As an enabling component for enhancing disease detection, the project also includes the development of an automated processing module for free-text laboratory microbiology reports. Utilizing this foundation, the project will significantly extend te set of diseases detected within ESP and complete the existing prototype ESP capabilities mentioned above. The project involves close collaboration with experts at the organization (the Harvard Department of Population Medicine) that led the original development work on ESP as well as with the MetroHealth System of Northeast Ohio, a regional healthcare provider that has been running ESP on a production basis since 2009.